When I broke my collarbone last year at DISC, I ended getting a second opinion and had mine plated self funded private.
I assumed incorrectly that CA insurance would cover most things so didn’t have private insurance at the time. Once I realised it wouldn’t, I did sign up for private insurance with no waiting period for physio post surgery which helped as I needed 16 sessions for a frozen shoulder!
$5000 minus the excess racks up extremely quickly! Anything Medicare rebatable isn’t covered by the CA insurance so you will be out of pocket there.
With mine, Hospital (stayed overnight) and stainless plate plus screws was around 4.7K. (This plus some of physio was covered by my Cycling Australia insurance).
Surgeon, Anaesthetist, Surgeons assistant plus x-rays etc came to just over $2.3K of which I got a bit under a third back from medicare.
Getting the money back was relatively easy. Just need to get all the relevant people to fill in their section and then you send it in. Had a few phone conversations with the insurer about the physio being included, as I got the Surgeon to fill in the form prior to realizing that my shoulder was frozen. So needed to get another letter from the surgeon to say it was indeed needed due to the crash.
In terms of physio and rehab, Medicare is pretty non-comprehensive. When I did my collarbone last year, they just had a physio come around as I was being discharged and gave me some exercises to do. As for the actual surgery, pretty straightforward and free.
$75 excess was for the whole claim and was deducted from my total reimbursement.
I went to a local physio I knew. My private health fund I signed up for paid $50 of each $84 physio session, the remaining $34 per session was included in my payout to the $5000 limit.
Whatever you do, get started on rehab as soon as possible!
My arm was immobile nearly 10 weeks in total - 2 weeks from crash to surgery as happened just before Easter plus time afterwards… Getting my frozen shoulder moving again was the most painful experience and took months of physical manipulation!
From memory pinning is more complex and slightly higher risk, but I don’t know that much about it. It’s always good to listen to the advice of a professional.